Arthritis Related to Infections 3% Flashcards
What infection can cause infectious sacroiliitis?
Brucellosis
Borreliosis may mimic ___.
Borreliosis may mimic OLIGOARTICULAR JIA.
Acute Lyme disease may mimic ___.
Acute Lyme disease may mimic OLIGOARTICULAR JIA. Lyme arthritis is an episodic oligoarthritis of large joints, usually asymmetrical, often involving the knee. Polyarticular arthritis is very rare –>prompt investigation for other rheumatic diseases.
A patient who immigrated from India presents to clinic with knee swelling that has been present for 3 months. The patient is well-appearing. There is boggy knee swelling with significant synovial thickening. The knee is nontender and is not red. What infectious etiology should be on the differential?
Tuberculosis
Parvovirus arthritis may mimic ___.
Parvovirus arthritis may mimic POLYARTICULAR JIA. Think young adult female with polyarticular involvement of small joints. Parvovirus can also trigger chronic JIA.
Rubella arthritis often involves the ___ and ___ joints
“Catcher syndrome.”
Rubella arthritis often involves the wrist and knee joints.
Think of this in young adult female who is unvaccinated or post-vaccine within 14-21 days.
The virus can be cultured/PCR-ed from the joint fluid.
A 4-year-old male presents with arthritis of his fingers that spread to his knees. There is joint pain with mild overlying erythema, warmth. He recently turned 4 2 weeks ago, is otherwise healthy, and is up to date with vaccines. What is on the differential other than JIA?
Rubella vaccine related arthritis
Arthralgia 7 days after rash (or 10-28 days after vaccine)
Joints of fingers then knees
Resolves within 3-4 weeks (can sometimes persist longer)
Pain, warmth, erythema and effusion
A 3-year-old male presents with acute onset limp and refusal to bear weight. He is afebrile and is otherwise healthy except for a URI last week. He cries when you try to abduct or internally rotate his left hip. His ESR is 23, CRP 1.2. What is the recommended treatment?
Transient synovitis
Diagnostic evaluation: US shows effusion
Treatment: NSAIDs
A 4-year-old male presents with acute onset left knee swelling with decreased ROM and fever. The knee is tapped and culture is negative. What other infectious etiology must be ruled out?
Kingella in patient < 5 years
What is the most common vector-borne infection in North America and Europe?
Lyme disease (Borrelia burgdorferi) is transmitted by hard-bodied ticks of the genus Ixodes Bonus points: Maine has the highest incidence of reported confirmed cases
A 9-year-old female with polyarticular joint pain and swelling x 3 months presents as a new patient. She is from Texas. Mother is concerned about Lyme. What would you discuss in terms of presentation and testing?
Polyarticular arthritis is very rare –>prompt investigation for other rheumatic diseases. Diagnosis of Lyme disease at stages other than erythema migrans requires serological confirmation utilizing a two-tier strategy with ELISA (high sensitivity, low specificity, rarely false negative, > 10% false positive) followed by Western blot confirmation (high specificity). All diagnostic tests bear the risk of false-negative or false-positive results. No test is of value in a patient with a low pretest probability of having Lyme arthritis.
Other one-tier testing used more so in Europe: Enzyme immunoassay to conserved internal sequence of vlsE1 (C6 peptide assay)
Note: Enzyme immunoassay may give false positive results related to cross reactivite anitbodies, such as rheumatoid factor, EBV, or other spirochetes (syphilis, Borrelia, leptospira)
